Volume 8, Issue 1, January – 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Association between Diabetes Mellitus and

Tuberculosis as a Global Issue
Author-- Khem Raj-MBBS, Diploma in Diabetes Mellitus, Medical Officer, Subsidiary Health Center, Taloor,
Block Narot Jaimal Singh, Teh/District Pathankot, Punjab Pin Code-145024, India Punjab

Abstract:- Diabetes mellitus and tuberculosis are chronic expected that with prevalence rate of 8.4% it will reach to 640
diseases and their association is existing for thousands of millions by 2040AD.
years, although association is not causal, but precipitating
to each other. As systemic reviews of many global databases In2016 there were 14.6millions tuberculosis patients, out
suggest that diabetes mellitus increases the risk of of which 1.6 millions died in a yr (4).
tuberculosis three times & tuberculosis impaires the glucose
tolerance levels (GTT), which in turn can lead to pre- A cohort study in taiwanese have 123546 participants with
diabetic stage & then diabetes mellitus. as per WHO report five year follow up period ,suggest that poor glycemic control
of 2014 there were 422 millions of diabetes mellitus cases in have doubled the rate of development tuberculosis (14) another
the world. It's likely to reach 624 millions by 2040 . There case control study done in Salvador, bawi, Brazil between
are 14.6 millions of tuberculosis cases & around 1.6 millions 2008to2010 which recruited 323new cases of tuberculosis have
tuberculosis patients die each yr. Global databases suggests positive bacciloscopy test & similar number as control group
that there are 15% diabetics are associated with with negative bacciloscopy test, OR-odds -Ratio found it is -
tuberculosis & 80-90%diabetic and tuberculosis patients 2.37 95% CI (1.04-5.42) as per global databases 15% of
are found in developing countries due to poverty, diabetic are associated with tuberculosis. Till date WHO have
malnutrition, poor health & sanitation, political instability highlighted the impending doom of diabetes mellitus and
& govt's lackadaisical attitude. present strategy for tuberculosis as emerging challenge to Modern world .so WHO
screening, diagnosis & management of TB and diabetes have cautioned the developing & high risk countries to adopt
mellitus is not halting the progression of Tuberculosis good clinical practices for cure & managementof tuberculosis
&diabetes, so we have to devise new strategy based on & diabetes mellitus . In spite of latest technology and new
research and latest technology to deal with combo medicines, both tuberculosis & diabetes mellitus are spreading
challenges, we have to make it compulsory for bidirectional at alarming rate for which we need a comprehensive result
screening, proper diagnosis & treatment & complete follow oriented strategy to control menace of tuberculosis & diabetes
up of all the cases. mellitus.

I. INTRODUCTION II. METHOD

Tubeeculosis &diabetes mellitus are chronic diseases pubmed & Google scholar databases were thoroughly
challenging the human beings survival from pre-neolithic era to searched using topics as diabetes mellitus & tuberculosis
Modern human beings ,earliest evidence of tuberculosis have association , incidence , prevalence rate ,their manifestations
been found in mummy of 30yrs old woman in 5803 BC in Italy mortality & morbidity rate , treatment outcomes are traced on
& another evidence of pthisis (TB) found in 4803 BC in Egypt excell wordsheet.
& in1552 BC Egyptian physician HESY-RA described
hyperglycemia ,another Indian physicians named CHARAK & III. RESULT
SASRUTA described the comorbidity features of diabetes
mellitus &tuberculosis as madhumeha and pthisis as; we have observed from the global databases studies that
meghanicola. (44) 15percentage of diabetics are associated with tuberculosis
although there is no evidence of any causal relationship. So
First documented study describing association between there should be bidirectional screening of diabetes mellitus &
diabetes mellitus and tuberculosis patients was done in neolithic tuberculosis.
era in 11th century by Arabian physician and philosopher
named AVICENNA (24). As per WHO report of 2014 there are Diabetes mellitus--epidemiological aspects --hesy-ra
422 millions of diabetes mellitus cases all over the world ,& Egyptian physician was The first in 1552 B.C to mention the
globally prevalence of diabetes mellitus cases have doubled hyperglycemia, what we name now a days as Diabetes mellitus,
from 1980- to2014 from 108 millions with prevalence rate 4.7% in 1500 B.C Indian physicians named CHARAK & SUSRUTA
to 422millions with prevalence rate 8.4%respectively. It is described The mysterious emaciating disease as Madhumeha

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Volume 8, Issue 1, January – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
(23) in which urine of patient usually attracted ant's, then First work on association of diabetes mellitus and
afterwards patients were diagnosed by taste of their urine,but Tuberculosis was done by AVICENNA-a Persian philosopher
time being there was no exact scientific & evidence based & physician in 980 to 1052 A.D , diabetes mellitus increases
therapy, finally in1922 in Canada at toranto based general the risk of Tuberculosis by three times(24).
hospital insulin extract was given by parentral route &results
were remarkable,in1955 first generation oral antidiabetic drug's IV. DISCUSSION
were introduced .
Diabetes mellitus a risk factor for Tuberculosis--patients
As per W.H.O report of2014there were 422 million with uncontrolled hyperglycemia are at risk of developing
diabetics in the world & since then diabetes mellitus have Tuberculosis three times as compared to general population. A
increased exponentially as evident from 1980 report have cohort study in Barcelona from 2000 to 2013 with 5849 TB
108million diabetics at prevalence rate 4.7percentage which patients, out of which 349 (5.9%) have diabetes mellitus, over
have doubled in 2014 to 422 million at prevalence rate 14yrs follow up period , diabetes mellitus prevalence rate was
8.5percentage &1.6 million diabetics have died in 2015 by 4% to 7.3% with ( Ci)- interval 95% however management of
diabetes mellitus and its complications (3). tuberculosis patients with diabetes mellitus was more
complicated.(34).
Tuberculosis--epidemiological aspects--following is the
estimated statistics report as per Another cohort study using databases from United
 W.H.O survey of 2016yr kingdom clinical practice research datalink of 222731patients
 Africa--417000 with diabetes mellitus diagnosed over 1990 to 2013, control
 America --17000 group have 1218616 subjects without Tuberculosis, over a
 Eastern Mediterranean--82000 period of24yrs it was observed that the Tuberculosis incidence
 Europe--26000 rate was higher in diabetics as compared with control group
 South east asia 652000 16.2%per lac in diabetics & 13.5%in control group.
 Western Pacific--103000
A case control study conducted in Salvador, bawi Brazil
from 2000 to 2010 which recruited 323 new cases of
Tuberculosis is chronic highly infectious disease since
prehistoric era creating havoc &devastation, disability of human tuberculosis with positive bacciloscopy test & similar number
beings (27). In ancient greece tuberculosis was called as of control group with negative bacciloscopy, then (odds ratio)
phthisis & in ancient Rome named as tabes, Schache peth in O.R-was observed as--2.37 C.I (confident interval)95%--(1.04-
5.42) which shows very significant association between
ancient Hebrew,in1700A.D tuberculosis was called as White
plague due to paleness of patients, in 1834 A.D Schonlein Tuberculosis & diabetes mellitus (36).
coined the term tuberculosis,in1882 A.D Dr Robert Koch first
Another longitudinal cohort study done in Chile from
discovered mycobacterium tubercule baccili as the caustive
1959 to 1982 prospectively with 10 yrs follow up period
agent of tuberculosis in human beings, in modern era
tuberculosis have varients like pulmonary TB, extrapulmonary revealed Tuberculosis incidence 24% in IDDM ( insulin
dependent diabetes mellitus) & 4.8%in type 2 diabetes mellitus
TB, drug resistant like MDR, XDR tuberculosis etc.(29) .
patients (9).
95%deaths due to Tuberculosis occurs in lower & middle
income countries, out of which65%deaths were in male adults.
Global view of the seven countries account for 64%of total TB RADIOLOGICAL Presentation in pulmonary Koch's with
diabetes mellitus--total 50 patients of pulmonary Tuberculosis
cases & India is frontrunner out of them followed by Indonesia,
who were on insulin or oral hypoglycemic drug's &have (FBS)
China, Pakistan, Philippines, Nigeria, Mozambique,
fasting blood sugar More than 140mg on two or more occasions
Now India have devised New strategy that is END-TB were included in this group
strategy goal 2025,for which India have to achieve target of 4-
5% annual fall of Tuberculosis incidence rate, as presently India 84% patients have lower lung Fields involvement while
have 2%annual fall of Tuberculosis incidence rate. 16% have upper lobe involvement ,32%have bilateral
involvement ,68% have unilateral involvement ,20% have
Association of Tuberculosis & diabetes mellitus ---on The cavitary Tuberculosis lung disease &80 % cavitary lung disease
global level there were 10.6 million active TB patients in the lesions wereconfined to lower lung Fields (17).
2016 &about one million have TB and diabetes mellitus as
SPUTOM SMEAR conversion-- A retrospective
combined &15% TB cases are confined to diabetes mellitus (2)
descriptive study done in FIJI from 2010 to 2012 in which 577
Tuberculosis patients were recruited, out of which 567 (98%)
have information regarding Tuberculosis,& 68 (12%) have
diabetes mellitus also, sputom smear conversion rate after two

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Volume 8, Issue 1, January – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
months of intensive phase treatment was non significant & [3]. Fatima-mukhtar, Butt-A Zahid--Cohart profile --diabetes
equivalent to Tuberculosis patients with or without diabetes mellitus-tuberculosis, BMJ-open(02 December
mellitus 78%Versus80% p=0.66, although diabetes mellitus is 2016,6(12)e012970) Doi:-10.1136/bmj open 201601290.
common in Tuberculosis patients but conversion rate was non [4]. world health organization- global report on diabetes
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